WPW Conduction Masking Ischæmia
Report:
Sinus rhythm 56/min
Intermittent Wolff-Parkinson-White ‘B’ conduction
Comment:
The last three beats are conducted normally, in V1 rhythm strip and anterolateral leads V4-6. The ST segment is straight and horizontal in V6, but not enough to comment on it in the report. However, at a faster rate (73/min, below, Fig 76a) the conduction is completely normal and the ST segment changes in 1, 2, V4-6 are suggestive of ischæmia, as are both the T wave and ST segment in lead 3.
Anomalous conduction may render exercise testing useless, although in this case normal conduction is likely to remain maintained at faster rates. Even so, in a 69 year old lady, radionuclide Persantin or stress echo study is preferable. Her m99Tc scan was negative.
This patient never had any arrhythmias – she has WPW conduction, but not the syndrome. Possibly, degenerative sclerosis or infarction involving her AV nodal pathway may give her permanent anomalous conduction one day.
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